Tucson Lifestyle February 2017 : Page 58

As we age, our immunity to disease declines. We talked to local experts to see what can be done to extend our healthspans. By: Britt any SemBar-myerS | Photogr aPhy By JameS P a trick IMMUNE STRUCK In Health any Americans seek a lon-ger life, and every year more of us surpass 100 years. However, lifespan is only half the picture; healthspan should be of equal or paramount impor-tance. “We have managed to extend lifespan quite a bit, but the health-span, as we call it, is really the quality of life. It’s what every-body wants,” explains Janko Nikolich-Žugich, M.D., Ph.D., who is the Co-Director of the UA Center on Aging, Elizabeth Bowman Professor and Head of the Department of Immunobiology, University of Arizona College of Medicine, a member of the UA BIO5 Institute, and Chairman of the Board & CEO of the American Aging Association. “Nobody wants to live another twenty years and be miserable with several chronic diseases.” M he guiding light of healthspan is our immune system. It’s our protection from the environment. Within the immune system are white blood cells, which protect the body from foreign pathogens. One type of white blood cell is the T cell, learning and recalling strategies of defense throughout our life. For this to work efficiently we must elicit the assistance T Fits To A “T” of naïve T cells. “We call the cells naïve T cells because they have never seen their microbe before,” says Dr. Nikolich-Žugich. “The way that this works is that we’ve got a huge army of these cells that is very, very diverse and capable of recognizing just about any microbe that’s going to attack us. In our youth we don’t have a prob-lem because our army is chock full of new recruits that are there to fight off these new infections but starting after puberty there begins an almost ten-fold drop in the abil-ity to make these cells.” After successful remediation of a foreign invader, some naïve T cells rewire themselves to become memory T cells. When the immune system encounters the same or very similar pathogens, the memory T cells can recall the effective strategies and quickly mount a defense. As we age the production of naïve T cells continues to drop. Consequently, protection from new infections and the response to known infections decreases. “Those that are the most danger-ous are the ones that people have not experienced in their life. Older people have a very hard time dealing with a completely new virus or bacteria that has been introduced into the popula-tion,” states Dr. Nikolich-Žugich. Although memory T cells sur-vive almost indefinitely, naïve T cells are necessary to continue 58 TUCSON LIFESTYLE | FEBRUARY 2017 TucsonLifestyle.com

In Health: Immune Struck

Brittany Sembar-Myers

As we age, our immunity to disease declines. We talked to local experts to see what can be done to extend our healthspans.

Many Americans seek a longer life, and every year more of us surpass 100 years. However, lifespan is only half the picture; healthspan should be of equal or paramount importance. “We have managed to extend lifespan quite a bit, but the healthspan, as we call it, is really the quality of life. It’s what everybody wants,” explains Janko Nikolich-Žugich, M.D., Ph.D., who is the Co-Director of the UA Center on Aging, Elizabeth Bowman Professor and Head of the Department of Immunobiology, University of Arizona College of Medicine, a member of the UA BIO5 Institute, and Chairman of the Board & CEO of the American Aging Association. “Nobody wants to live another twenty years and be miserable with several chronic diseases.”

Fits to A “T”

The guiding light of healthspan is our immune system. It’s our protection from the environment. Within the immune system are white blood cells, which protect the body from foreign pathogens. One type of white blood cell is the T cell, learning and recalling strategies of defense throughout our life. For this to work efficiently we must elicit the assistance of naïve T cells. “We call the cells naïve T cells because they have never seen their microbe before,” says Dr. Nikolich-Žugich. “The way that this works is that we’ve got a huge army of these cells that is very, very diverse and capable of recognizing just about any microbe that’s going to attack us. In our youth we don’t have a problem because our army is chock full of new recruits that are there to fight off these new infections but starting after puberty there begins an almost ten-fold drop in the ability to make these cells.”

After successful remediation of a foreign invader, some naïve T cells rewire themselves to become memory T cells. When the immune system encounters the same or very similar pathogens, the memory T cells can recall the effective strategies and quickly mount a defense.

As we age the production of naïve T cells continues to drop. Consequently, protection from new infections and the response to known infections decreases. “Those that are the most dangerous are the ones that people have not experienced in their life. Older people have a very hard time dealing with a completely new virus or bacteria that has been introduced into the population,” states Dr. Nikolich-Žugich. Although memory T cells survive almost indefinitely, naïve T cells are necessary to continue to fight new pathogens. From our white blood cells, the cells that fight infections are being generated in our 50s at onethousandth the rate of our youth.

“The influenza virus is typically a very serious problem for older communities. The reason why it’s a problem is because the virus changes, so the fact that we had it once doesn’t protect us from a new variant.” Although the immune system often can adapt to changing infectious diseases, it is less efficient at an older age. Thus, When diseases mutate they can cause lengthier recovery times. Or when infections strike simultaneously, or before new production of cells, the results can be devastating.

“The good news is they’re not completely stopped and that gives us possibilities to try and rejuvenate the immune system,” relays Dr. Nikolich-Žugich. “We have an active project right now, and we’re hoping to get substantial funding to continue, to study how to rejuvenate the immune system and to reignite new production as well as to improve function of these cells.” Dr. Ryan M. Kretzer

TAKING OUR BEST SHOTS

On its own the immune system can fight, learn, recall and develop a vast repository of strategies to fight infections. With the help of medical science, the immune system can prepare for an invasion of deadly pathogens by way of immunizations. Two ways that immunizations work is by introducing active or inactive viruses. Inactivated and attenuated (“live”) vaccines initiate a response by the immune system to develop defenses, similar to contracting the virus. Inactivated vaccines can be dead or altered pathogens that stimulate immune cell memory with little to no risk of infection but might be too weak for an adequate response and require booster doses. “Live” vaccines utilize pathogens that are less virulent and reproduce very slowly, allowing the immune system to attack and produce memory cells for future application.

Without vaccinations, people would need to acquire the live, full-strength pathogen to develop defenses. Unfortunately, many infectious diseases are life-threatening. Even if the viruses or bacteria are not lethal to a large spectrum of the population they can still be deadly for vulnerable individuals like seniors. “The biggest issues are things like influenza in the older population and pneumococcus,” says Dr. Nikolich-Žugich.

The age at which function of the immune system decreases varies. Many factors can contribute to when and by how much. “If you look at various infectious diseases you can simply chart how frequent the severe forms of that disease are in a human population and at what ages. And there is an emerging consensus that sometime between forty and fifty most people are starting to show signs of measurable decline,” states Dr. NikolichŽugich.

Past and continued research has provided meaningful connections between immunity and detectable factors other than age. Some bacteria and viruses live forever in the human body, some good, some not so good. The cytomegalovirus (CMV) is a fairly common virus that many people have and the reason why it may be unfamiliar to most is because it generally lives within a person without creating symptoms. The virus can circulate and reactivate throughout the body. “The question is, when it activates, what is it doing when your immune system is good?” Dr. Nikolich-Žugich poses. Research has traced when the virus is active and it hopes to determine whether its presence is desired or dreaded, because there is evidence on both sides. “The helpful side is something that is a little more perplexing and fascinating and could we use it to improve the immune system through the action of that virus.”

TWO, FOUR, SIX, EIGHT — THEY’RE ALL HERE TO ADVOCATE

Immune function may decrease as we age, but proactive preventive measures can help you to stay healthier. Being involved in your own health care is the first step, along with finding medical professionals who are equally invested in your well-being.

One such example is Iora Primary Care in Tucson, which has two locations both specializing in the care of seniors. One facility is on Grant and Alvernon. The other is on Broadway and Camino Seco where Miki Crane, M.D., is the medical director. Care at Iora is centered around patients who are 65 years old or older, and who have a Humana Medicare Advantage Plan. The medical office is designed to meet the needs of many seniors, with wide halls, carpetless floors and handrails on the walls. “Our main focus actually is on the patients themselves. We take the time to listen to what their concerns are and what it is they brought to the table for that particular appointment.”

At Iora, each patient’s care plan is individualized, but structured around a team-based approach. In addition to the doctor and nurse, the team may be composed of mental and behavioral specialists and health coaches. The team also can include family and caregivers to ensure a firm grasp on what needs to be accomplished to return the patient to health or to continue with a healthy life. “We include family members and caregivers to make sure we’re all on the same page and we’re understanding the plan. Otherwise the vulnerability of seniors is really scary, especially when they don’t have any support out there.” For the patients who may benefit from community outreach there are resources that Iora is able to connect them with, like the Pima Council on Aging. “Humana has case managers and social workers who may discuss patients who come up on our radar and we’re concerned about how they’re doing once they leave the clinic,” adds Dr. Crane.

One unique aspect of care at Iora is the inclusion of a health coach. Health coaches assist patients in lifestyle changes, ensure a crucial understanding of continued medical care and at the core are advocates for the patient. For patients with diabetes, a health coach can help adjust their diets. For patients with pain or stiffness, they can demonstrate safe exercises or stretches to alleviate pain or strengthen parts of the body. In addition, health coaches can recommend educational materials, like books or websites with pertinent information. Further still (under medical direction) they may uncover a cheaper alternative to current medications. Dr. Crane adds, “What a lot of our health coaches like to do is to help patients meet health goals. And what happens behind the scenes goes unnoticed and I think unrecognized, but they really are in charge of trying to get the referrals through that we need.”

Health is As Healthy Does

Providers are aware that the elderly often may not feel well and believe it is simply a sign that their body is, in fact, aging. There is never any harm in expressing that concern because often the vague “not feeling well” symptom may be the only sign that an illness is underway.

“As you get older, your immune system does decline,” Dr. Crane explains. “Seniors are more vulnerable to infections and those who are a little bit more vulnerable would be those with chronic diseases, such as diabetes.” Additional risk factors would be people on certain medications for diseases like rheumatoid arthritis and cancer.

In addition to certain conditions that may predispose people to a heightened infection risk, nutrition ranks high in Iora’s assessment of immune health. Specifically, a person’s ability to afford good nutrition and the ability to feed himself. Physical activity tailored to one’s own fitness level is important. Also, practicing good habits like washing your hands and avoiding areas where you may catch a cold. Immunizations, and a patient’s chosen treatment path, round out the many avenues available to maintain or boost immune health.

Even with extra precautions, catching a virus or bacteria is still a constant threat. “Even if it’s just a virus and there’s no indication for antibiotics, we can bring patients in and give them support for homecare,” Dr. Crane continues, “We do have a lot of folks with lung conditions like COPD, and we encourage them all the time to come in early enough so we’re able to prevent pneumonia.” Pneumonia and the flu are in the top 10 causes of death for seniors and both are treatable — if caught early.

Due to the decline in the immune system, responses to infection can become lacking and symptoms of illness may not present in any classical sense. Often detective work is required to uncover the cause of a patient claiming to just not feel good.

Certain conditions can interfere with the body’s ability to fight infections aggressively, but even when that is not the case the medications one needs can suppress the immune response or partly mask symptoms.

For all the efforts made to protect the immune system there are still far more unknowns to contend with. Research is making progress on multiple fronts, but the application of these discoveries may not be applicable for some time, making it all the more important to begin strengthening our immune systems as soon as possible.

How To Preserve Your Body And Mind

Tips from Janko Nikolich-Žugich, M.D., Ph.D., Co-Director of the UA Center on Aging, Elizabeth Bowman Professor and Head of the Department of Immunobiology, University of Arizona College of Medicine, a member of the UA BIO5 Institute, and Chairman of the Board & CEO of the American Aging Association

• Exercise daily — moderate intensity; get your heart rate up for at least 30 minutes per day — this is important for the body, and even more important for the mind.

• Exercise: “As we age, an active lifestyle with regular exercise becomes even more important. Exercise helps to reduce joint pain and boosts our energy/immune system. I suggest walking, jogging, yoga, or any other physical activity you enjoy that gets you out and active.”

• Frequency of physical activity: “Talk to your doctor about an exercise regimen that works best for your body and health goals, but overall, exercising three to four times per week for 30 minutes will help you feel better as you get older.”

2) Proper Nutrition

• Healthy Food Choices: “I always say you can’t get enough vegetables and fruits to keep yourself healthy. I suggest focusing your diet on vegetables, fruits, lean proteins and healthy carbohydrates (such as couscous, brown rice, whole grain breads and quinoa). Limit or avoid foods with refined sugar. These foods come in the form of cakes, cookies, regular soda, fruit drinks and dairy desserts. If you can find sugar in the ingredient list on any packaged food, try to find a healthy alternative in the form of a whole food, such as an apple with peanut butter (without sugar).”

• Slow Down: “Sometimes we overeat because we’re simply eating too quickly. When sitting down for a meal, put down your fork in between bites, take time to talk with others at the table and be mindful of how quickly you’re eating your meal.”

• Portion Control: “Eating more consistent, small meals throughout the day, versus large meals three times a day, will keep you more satisfied and sustained throughout your waking hours. Portion control becomes easier when you’re not starving at mealtime.”

3) Activities for Mind, Body and Spirit

• Socializing: “Depression is common as we age in part due to loneliness resulting from spending more time alone, loss of a spouse and/or friends. I suggest getting involved in your community, either by volunteering or joining a group with your same interests. At Iora Primary Care, we offer free classes that are open to all adults 65 and older. To learn more about our classes, visit: www.ioraprimarycare.com.”

• Brain Health: “Everything from jigsaw puzzles to crosswords can help improve brain function as we age. Try learning a new skill, such as a language class, or honing an old skill, like gardening, to improve brain health. These activities will help to keep you sharp.”

• Sexual Health: “A lot of people discount sexual health as an important part of aging, but I think it’s as important as it is in other stages of life. Sexual health means different things to different people. If you are finding this aspect of your life challenging, I recommend talking to a doctor or therapist about your thoughts and desires on this subject. He or she can provide suggestions for either medications or holistic options to increase your sexual drive. For more information on sexual health as you age, check out a blog post on Iora Primary Care’s Live Better Blog by one of my colleagues, Dr. Matt Schlough.”

“The Arizona Center on Aging and the Department of Immunobiology has been working now over the last eight plus years to really understand how and why older adults’ immune systems are no longer protected from frequent infectious diseases, like influenza and pneumonia.”

— Janko Nikolich-Žugich, M.D., Ph.D., Co-Director of the UA Center on Aging, Elizabeth Bowman Professor and Head of the Department of Immunobiology, University of Arizona College of Medicine, a member of the UA BIO5 Institute, and Chairman of the Board & CEO of the American Aging Association.

“Before my present position, I never have been able to have a job where I could sit down and actually not feel rushed when talking to a patient to really have a chance to listen to them and be able to offer them help.”